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General NPI Number Information
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NPI Number | 1396167102
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Entity Type | Individual
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Provider Name | MICHAEL CHRISTOPHER HAYDEL DDS
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Gender | Male
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 910 BERT KOUNS INDUSTRIAL LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71118-3410
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Country | US
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Telephone | 318-686-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 BAYOU CIR
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City | BOSSIER CITY
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State | LA
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Zip | 71112-4034
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Country | US
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Telephone | 318-464-0902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6362
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License Number State | LA
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